DI 20505.010:
Disability Determination Services (DDS) Locates a Prior Paper Folder
Effective Dates: 07/09/2012 - Present- Effective Dates: 10/31/2017 - Present
TN 2 (11-01)- TN 3 (10-17)
DI 20505.010 Determining Need For Prior Folder- DI 20505.010 Disability Determination Services (DDS) Locates a Prior Paper Folder
A. Procedure - DDS additional action- A. Field office (FO) role in documenting prior filings
The FO will associate any prior folder with the current claim or document the claim to identify prior claims activity when it is sent to the DDS. If the FO documents prior claims activity and does not request or associate the prior folder with the current claim or the DDS has a need for the prior folder, the DDS must take additional action.- Before sending a claims folder to the DDS, the FO determines whether the claimant has previously filed for any type of benefit or payment and documents prior claims activity on the EDCS 3367 or paper SSA-3367 (Disability Report – Field Office). For electronic folder instructions, see DI 81020.030 – Prior Folder Material.
When the current claim is received in DDS, all information on the SSA-3367, SSA-3368, SSA-3820, etc., plus documentation about prior claims activity will be reviewed. DDS will initiate any necessary medical development immediately. Duplicate evidence related to the prior claim should not be requested, if it is apparent that the prior file will be received and that the prior file will contain that evidence.- DDS may need to review actions on claims when there is a prior determination. This chapter explains how to determine the need for a prior folder and DDS procedures for the retrieval of a prior folder.
B. Procedure - DDS will not request prior folder- B. When to request the prior folder
The prior file would not routinely be needed if:* There is no possible reopening issue (DI 27500.000); or* The file shows that any onset date which might be established occurs after the disability earnings requirement is last met; or* An allegation is made that “onset” occurred within the past year and medical evidence submitted does not indicate the presence of an impairment(s) which might warrant an onset more than one year ago; or* Work that is determined to be SGA was performed during the l-year period preceding the filing date of the current application.C. Procedure - DDS must request prior folderIn some cases, it is necessary to have the prior folder in order to adjudicate a current claim. Some examples of when a prior folder is needed for the current determination are:EXAMPLE - 1 Current title II claim- Prior SSI Allowance (Unless SSI was a conversion case) - Collateral Estoppel, See DI 27515.000.- If the FO did not request a prior paper folder and DDS determines the prior paper folder is necessary in order to adjudicate a current claim; DDS must take additional action to obtain the prior paper folder. These situations should be infrequent and are usually due to the need to establish longitudinal medical history or a mental impairment.
EXAMPLE - 2 Evidence in the current claim suggests possible reopening. (See DI 27500.000 - Reopenings and Administrative Finality.)- 1. Routine requests for the prior paper folder
EXAMPLE - 3 Acquiescence Rulings that require consideration prior findings of an Administrative Law Judge or Appeals Council when making a disability determination arising under the same or different title of the ACT (See DI 32700.000 and DI 52700.000.)- Routinely request the prior folder (if the FO has not already submitted a request) in the following situations:
- * The claimant filed a current Title II claim and has a prior SSI allowance (Unless SSI was a conversion claim); (See DI 27515.000 – Collateral Estoppel)
- * Evidence in the current claim suggests a possible reopening; (See DI 27500.000 – Reopening, Adoptions, and Refilings);
- * An acquiescence ruling requires DDS to consider the prior Administrative Law Judge or Appeals Council findings when making a disability determination arising under the same or different Title of the Social Security Act (The Act.);
- * Evidence in file indicates fraud or similar fault may be involved in the current or prior claim;
- * A prior allowance exists and benefits were ceased for non-medical reasons.
Example - 4 Evidence in file indicates fraud or similar fault may be involved in the current or prior claim (See DI 23025.015).- 2. Situations when the prior paper folder may not be needed
If the FO has not requested the prior folder in these cases, the DDS must do so. If the FO has requested the prior folder, but it has not been received, follow-ups by DDS should be directed to the FO or other component that housed the prior folder.If in reviewing the current claims folder for other types of claims, the DDS determines that a prior folder is necessary for current adjudication, the DDS should take the action to obtain the folder. These situations should be infrequent and will usually be the result of the need for DDS to establish a longitudinal medical history or to establish a mental impairment.Do not initiate requests for duplicate medical evidence that should already be housed in the prior folder.- Do not routinely request the prior folder in the following situations:
- * There is no possible reopening issue (DI 27500.000); or
- * The potential onset date occurs after the disability earnings requirement is last met; or
- * The alleged onset date occurred within the past year and medical evidence submitted does not indicate the presence of an impairment(s) which might warrant an onset more than one year ago; or
- * The claimant engaged in substantial gainful activity (SGA) during the l-year period preceding the filing date of the current application.
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